Clinical simulation in teaching nursing students: Scoping review
DOI:
https://doi.org/10.62741/ahrj.v2i3.64Keywords:
Students, Nursing, Simulation Training, Education, Nursing, Scoping ReviewAbstract
Introduction: Clinical simulation is an innovative teaching methodology that is widely recognised in nursing training for its ability to promote technical, relational and critical skills in a safe environment. It allows students to apply theoretical knowledge, develop clinical reasoning and acquire self-confidence before entering real care contexts.
Objectives: To map the available scientific evidence on the use of clinical simulation in teaching nursing students, identifying perceived benefits and barriers to its implementation.
Methodology: Follows Joanna Briggs Institute methodology and PRISMA-ScR guidelines. The March 2025 search used "Students, Nursing", "Simulation Training" and "Education, Nursing" in MEDLINE® Complete (via PubMed); CINAHL® Complete, MedicLatina® and Cochrane Central Register of Controlled Trials® (via EBSCOhost®). Included free full-text studies in any language, selected by two independent reviewers, with a third reviewer in the event of disagreement.
Results: Main benefits: increased self-efficacy and confidence; development of technical skills; reflection and critical thinking; satisfaction and efficiency in learning. Obstacles to implementation: emotional and psychological challenges; training and support for teachers/supervisors; limitations of physical, human and financial resources; logistical problems and poor curriculum integration; lack of realism and limitations of simulated scenarios; insufficient preparation of students; initial resistance; ethical and emotional demands.
Conclusion: Clinical simulation is a valuable educational tool in nursing, improving readiness for complex clinical situations. Effective implementation requires institutional support, educator training, and emotional support. This review underscores the need for structured curriculum integration and further research into the long-term impact and effectiveness of simulation in real-world clinical practice.
References
Daniel MDC, Galante JFR, de Paiva Furtado JA, da Silva ML, Batista PVS, de Souza RF, et al. Contribuições no processo de ensino aprendizagem da prática de simulação realística: uma revisão sistemática. Res Soc Dev. 2021;10(14):e303101421956. doi:10.33448/rsd-v10i14.21956 DOI: https://doi.org/10.33448/rsd-v10i14.21956
Gonçalves SAT. Sentimentos estressores em estudantes de enfermagem no processo de ensino-aprendizagem utilizando a simulação realística: uma revisão de escopo. [dissertação]. 2022. Disponível em: http://tede2.unifenas.br:8080/jspui/handle/jspui/308
Meschial WC, de Paula A, Nespollo AM, de Lima MF, Marin SM, de Castro VC. Explorando a utilização da simulação clínica no ensino de Enfermagem em emergência: uma revisão integrativa. Rev Enferm Cent-Oeste Min. 2024;14. doi:10.19175/recom.v14i0.5148 DOI: https://doi.org/10.19175/recom.v14i0.5148.
Lei, Y. Y., Zhu, L., Sa, Y. T. R., & Cui, X. S. (2022). Effects of highfidelity simulation teaching on nursing students' knowledge, professional skills and clinical ability: A meta-analysis and systematic review. Nurse education in practice, 60, 103306. doi:https://doi.org/10.1016/j.nepr.2022.103306 DOI: https://doi.org/10.1016/j.nepr.2022.103306
Alrashidi, N., Pasay an, E., Alrashedi, M. S., Alqarni, A. S., Gonzales, F., Bassuni, E. M., ... & Ahmed, K. E. (2023). Effects of simulation in improving the self-confidence of student nurses in clinical practice: a systematic review. BMC Medical Education, 23(1), 815. doi:https://doi.org/10.1186/s12909-023-04793-1 DOI: https://doi.org/10.1186/s12909-023-04793-1
Alharbi, A., Nurfianti, A., Mullen, R. F., McClure, J. D., & Miller, W. H. (2024). The effectiveness of simulation-based learning (SBL) on students’ knowledge and skills in nursing programs: a systematic review. BMC medical education, 24(1), 1099. doi:https://doi.org/10.1186/s12909-024-06080-z DOI: https://doi.org/10.1186/s12909-024-06080-z
Peters MDJ, Marnie C, Tricco AC, Pollock D, Munn Z, Alexander L, et al. Updated methodological guidance for the conduct of scoping reviews. JBI Evid Synth. 2020;18(10):2119-2126. doi:10.11124/JBIES-20-00167 DOI: https://doi.org/10.11124/JBIES-20-00167
Tricco A, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018;169(7):467-473. doi:10.7326/M18-0850 DOI: https://doi.org/10.7326/M18-0850
Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan - a web and mobile app for systematic reviews. Syst Rev. 2016;5:210. doi:10.1186/s13643-016-0384-4 DOI: https://doi.org/10.1186/s13643-016-0384-4
He X, Rong X, Shi L, et al. Peer-led versus instructor-led structured debriefing in high-fidelity simulation: a mixed-methods study on teaching effectiveness. BMC Med Educ. 2024;24(1):1-11. doi:10.1186/s12909-024-06262-9 DOI: https://doi.org/10.1186/s12909-024-06262-9
Jin E, Kang H. Development and effect of hybrid simulation program for nursing students: focusing on a case of pediatric cardiac catheterization in Korea: quasi-experimental study. Child Health Nurs Res. 2024;30(4):277. https://pmc.ncbi.nlm.nih.gov/articles/PMC11532356/ DOI: https://doi.org/10.4094/chnr.2024.020
Lugo RG, Hjelmeland I, Hansen MT, et al. Impact of initial emotional states and self-efficacy changes on nursing students’ practical skills performance in simulation-based education. Nurs Rep. 2021;11(2):267-278. doi:10.3390/nursrep11020026 DOI: https://doi.org/10.3390/nursrep11020026
Fuglsang S, Bloch CW, Selberg H. Simulation training and professional self-confidence: A large-scale study of third year nursing students. Nurse Educ Today. 2022;108:105175. doi:10.1016/j.nedt.2021.105175 DOI: https://doi.org/10.1016/j.nedt.2021.105175
Yang SY. Effectiveness of neonatal emergency nursing education through simulation training: Flipped learning based on Tanner’s Clinical Judgement Model. Nurs Open. 2021;8(3):1314-1324. doi:10.1002/nop2.748 DOI: https://doi.org/10.1002/nop2.748
Eide WM, Johansson L, Eide LS. First-year nursing students’ experiences of simulation involving care of older patients. A descriptive and exploratory study. Nurse Educ Pract. 2020;45:102797. doi:10.1016/j.nepr.2020.102797 DOI: https://doi.org/10.1016/j.nepr.2020.102797
Nakayama N, Ejiri H, Arakawa N, Makino T. Role of peer learning and self-efficacy in parasympathetic activity during the simulation learning process in nursing students. Nurs Open. 2023;10(2):552-559. doi:10.1002/nop2.1321 DOI: https://doi.org/10.1002/nop2.1321
Linn AC, de Souza EN, Caregnato RCA. Simulation in cardiorespiratory arrest: assessment of satisfaction with the learning of nursing students. Rev Esc Enferm USP. 2021;55:e20200533. doi:10.1590/1980-220X-REEUSP-2020-0533 DOI: https://doi.org/10.1590/1980-220x-reeusp-2020-0533
Chow KM, Ahmat R, Leung AW, Chan CW. Is high-fidelity simulation-based training in emergency nursing effective in enhancing clinical decision-making skills? A mixed methods study. Nurse Educ Pract. 2023;69:103610. doi:10.1016/j.nepr.2023.103610 DOI: https://doi.org/10.1016/j.nepr.2023.103610
Escribano S, Cabañero-Martínez MJ, Fernández-Alcántara M, et al. Efficacy of a standardised patient simulation programme for chronicity and end-of-life care training in undergraduate nursing students. Int J Environ Res Public Health. 2021;18(21):11673. doi:10.3390/ijerph182111673 DOI: https://doi.org/10.3390/ijerph182111673
Andrade IRC, Queiroz JCD, Farias MS, Maia NPDS, Silva LDFD. Clinical simulation in the teaching of cardiovascular physical examination with nursing students: a systematic review. Rev Bras Enferm. 2025;78(1):e20230429. doi:10.1590/0034-7167-2023-0429 DOI: https://doi.org/10.1590/0034-7167-2023-0429pt
Tamaki T, Inumaru A, Yokoi Y, et al. The effectiveness of end-of life care simulation in undergraduate nursing education: A randomized controlled trial. Nurse Educ Today. 2019;76:1-7. doi:10.1016/j.nedt.2019.01.005 DOI: https://doi.org/10.1016/j.nedt.2019.01.005
Jiménez-Rodríguez D, Belmonte García MT, Santillán García A, et al. Nurse training in gender-based violence using simulated nursing video consultations during the COVID-19 pandemic: A qualitative study. Int J Environ Res Public Health. 2020;17(22):8654. doi:10.3390/ijerph17228654 DOI: https://doi.org/10.3390/ijerph17228654
Eade AC, Winter C. Using simulated practice in pre-registration education to explore mental health issues. Br J Nurs. 2017;26(12):690-694. doi:10.12968/bjon.2017.26.12.690 DOI: https://doi.org/10.12968/bjon.2017.26.12.690
McConville SA, Lane AM. Using on-line video clips to enhance self-efficacy toward dealing with difficult situations among nursing students. Nurse Educ Today. 2006;26(3):200-208. doi:10.1016/j.nedt.2005.09.024 DOI: https://doi.org/10.1016/j.nedt.2005.09.024
Simonelli-Muñoz AJ, Jiménez-Rodríguez D, Arrogante O, et al. Breaking the stigma in mental health nursing through high-fidelity simulation training. Nurs Rep. 2023;13(4):1593-1606. doi:10.3390/nursrep13040132 DOI: https://doi.org/10.3390/nursrep13040132
Okuroglu GK, Orak NS, Sahin S, Alpar SE. The effect of simulation training on first-year nursing students' ability on planning nursing process and their clinical stress levels. Turk Klin J Nurs Sci. 2021;13(3):581-589. doi:10.5336/nurses.2020-78920 DOI: https://doi.org/10.5336/nurses.2020-78920
Nazari P, Parsai-Manesh E, Kazemi Z, et al. Evaluation of advanced multi-purpose trauma moulage-based training on clinical skills for dealing with trauma-affected individuals in undergraduate nursing students. Int J Emerg Med. 2024;17(1):116. doi:10.1186/s12245-024-00704-3 DOI: https://doi.org/10.1186/s12245-024-00704-3
Lee U, Choi H, Jeon Y. Nursing students’ experiences with computer simulation-based communication education. Int J Environ Res Public Health. 2021;18(6):3108. doi:10.3390/ijerph18063108 DOI: https://doi.org/10.3390/ijerph18063108
Li YY, Au ML, Tong LK, Ng WI, Wang SC. High-fidelity simulation in undergraduate nursing education: A meta-analysis. Nurse Educ Today. 2022;111:105291. doi:10.1016/j.nedt.2022.105291 DOI: https://doi.org/10.1016/j.nedt.2022.105291
Tong LK, Li YY, Au ML, Wang SC, Ng WI. High-fidelity simulation duration and learning outcomes among undergraduate nursing students: A systematic review and meta-analysis. Nurse Educ Today. 2022;116:105435. doi:10.1016/j.nedt.2022.105435 DOI: https://doi.org/10.1016/j.nedt.2022.105435
Lockertsen Ø, Løvhaug L, Davik NK, et al. Second-year undergraduate nursing students’ experiences with clinical simulation training in mental health clinical practice: A focus group study. Nurse Educ Pract. 2023;66:103534. doi:10.1016/j.nepr.2022.103534 DOI: https://doi.org/10.1016/j.nepr.2022.103534
Martins T, Santos F, Lumini MJ, et al. Realistic simulation in nursing education: Testing two scenario-based models. Nurs Open. 2023;10(5):3326-3335. doi:10.1002/nop2.1585 DOI: https://doi.org/10.1002/nop2.1585
Abarca LLM, Barros ALBLD, Baptista RCN, Batista REA, Lopes JDL. Effect of video on satisfaction and self-confidence in simulation training: a randomized clinical trial. Rev Bras Enferm. 2023;76:e20220366. doi:10.1590/0034-7167-2022-0366 DOI: https://doi.org/10.1590/0034-7167-2022-0366
Guerrero JG, Rosales NS, Castro GMT. Impact of high-fidelity simulation exposure of nursing students with their objective structured clinical examination: A quasi-experimental study. Nurs Open. 2023;10(2):765-772. doi:10.1002/nop2.1343 DOI: https://doi.org/10.1002/nop2.1343
Cabañero-Martínez MJ, Escribano S, Sánchez-Marco M, Juliá- Sanchis R. Effectiveness of a standardised patient simulation programme in undergraduate nursing students 6 months after implementation: A quasi-experimental study. Nurs Open. 2023;10(7):4747-4755. doi:10.1002/nop2.1726 DOI: https://doi.org/10.1002/nop2.1726
Del Pino FJP, Arrogante O, Simonelli-Munoz AJ, Gallego-Gómez JI, Jiménez-Rodríguez D. Use of high-fidelity clinical simulation for the development of cultural competence of nursing students. Nurse Educ Today. 2022;116:105465. doi:10.1016/j.nedt.2022.105465 DOI: https://doi.org/10.1016/j.nedt.2022.105465
Chabrera C, Curell L, Rodríguez-Higueras E. Effectiveness of high versus mixed-level fidelity simulation on undergraduate nursing students: A randomised controlled trial. Nurse Educ Pract. 2025;82:104206. doi:10.1016/j.nepr.2024.104206 DOI: https://doi.org/10.1016/j.nepr.2024.104206
Presado MHCV, Colaço S, Rafael H, et al. Learning with high fidelity simulation. Cienc Saude Colet. 2018;23:51-59.
doi:10.1590/1413-81232018231.23072017 DOI: https://doi.org/10.1590/1413-81232018231.23072017
Quemada-González C, Becerra-Martos EF, Blenkarn M, et al. Nursing students' experience of approaching risk for suicide behaviour through simulated environments: A content analysis study. Arch Psychiatr Nurs. 2024;50:5-13. doi:10.1016/j.apnu.2024.03.001 DOI: https://doi.org/10.1016/j.apnu.2024.03.001
Larti N, Ashouri E, Aarabi A. The effects of an empathy role-playing program for operating room nursing students in Iran. J Educ Eval Health Prof. 2018;15. doi:10.3352/jeehp.2018.15.29 DOI: https://doi.org/10.3352/jeehp.2018.15.29
Nunes JGP, Amendoeira JJP, Cruz DALM, et al. Clinical judgment and diagnostic reasoning of nursing students in clinical simulation. Rev Bras Enferm. 2020;73(6):e20180878. doi:10.1590/0034-7167-2018-0878 DOI: https://doi.org/10.1590/0034-7167-2018-0878
Boostel R, Felix JVC, Bortolato-Major C, Pedrolo E, Vayego SA, Mantovani MDF. Stress of nursing students in clinical simulation: a randomized clinical trial. Rev Bras Enferm. 2018;71:967-974. doi:10.1590/0034-7167-2017-0187 DOI: https://doi.org/10.1590/0034-7167-2017-0187
Vangone I, Arrigoni C, Magon A, et al. The efficacy of high-fidelity simulation on knowledge and performance in undergraduate nursing students: An umbrella review of systematic reviews and meta-analysis. Nurse Educ Today. 2024;106231. doi:10.1016/j.nedt.2024.106231 DOI: https://doi.org/10.1016/j.nedt.2024.106231
Yang F, Wang Y, Yang C, et al. Improving clinical judgment by simulation: a randomized trial and validation of the Lasater clinical judgment rubric in Chinese. BMC Med Educ. 2019;19:1-6. doi:10.1186/s12909-019-1454-9 DOI: https://doi.org/10.1186/s12909-019-1454-9
Carrero-Planells A, Pol-Castaneda S, Alamillos-Guardiola MC, et al. Students and teachers' satisfaction and perspectives on highfidelity simulation for learning fundamental nursing procedures: A mixed-method study. Nurse Educ Today. 2021;104:104981. doi:10.1016/j.nedt.2021.104981 DOI: https://doi.org/10.1016/j.nedt.2021.104981
Kunst EL, Mitchell M, Johnston AN. Using simulation to improve the capability of undergraduate nursing students in mental health care. Nurse Educ Today. 2017;50:29-35. doi:10.1016/j.nedt.2016.12.012 DOI: https://doi.org/10.1016/j.nedt.2016.12.012
Jeong JH, Kim EJ. Development and evaluation of an SBARbased fall simulation program for nursing students. Asian Nurs Res. 2020;14(2):114-121. doi:10.1016/j.anr.2020.04.004 DOI: https://doi.org/10.1016/j.anr.2020.04.004
Teles MG, Mendes-Castillo AMC, Oliveira-Kumakura ARDS, Silva JLG. Clinical simulation in teaching Pediatric Nursing: students’ perception. Rev Bras Enferm. 2020;73(2):e20180720. doi:10.1590/0034-7167-2018-0720 DOI: https://doi.org/10.1590/0034-7167-2018-0720
Wilford A, Doyle TJ. Integrating simulation training into the nursing curriculum. Br J Nurs. 2006;15(17):926-930.
doi:10.12968/bjon.2006.15.17.21907 DOI: https://doi.org/10.12968/bjon.2006.15.17.21907
Hammoud S, Browne F, Lenane P, et al. Evaluating the use of 3D skin models as simulation-based educational tools among nursing students: A quasi-experimental study. Nurse Educ Today. 2025;146:106519. doi:10.1016/j.nedt.2024.106519 DOI: https://doi.org/10.1016/j.nedt.2024.106519
Kim E, Kim SS, Kim S. Effects of infection control education for nursing students using standardized patients vs. peer role-play. Int J Environ Res Public Health. 2021;18(1):107. doi:10.3390/ijerph18010107 DOI: https://doi.org/10.3390/ijerph18010107
Parlak EA, Ayhan H, Erer İ, Iyigun E. The effect of virtual realitybased operating room tour on nursing students' anxiety, stress and self-confidence levels in an operating room setting: a randomized controlled trial. Nurse Educ Pract. 2025;104380. doi:10.1016/j.nepr.2025.104380 DOI: https://doi.org/10.1016/j.nepr.2025.104380
Van de Weyer G, White K, Franck E, et al. Evaluating anxiety and self-confidence in nursing students: Adaptation and validation of the NASC-CDM scale for high-fidelity simulation training. Clin Simul Nurs. 2024;96:101618. doi:10.1016/j.ecns.2024.101618 DOI: https://doi.org/10.1016/j.ecns.2024.101618
Wojcieszek A, Kurowska A, Wróbel A, et al. Analysis of high-fidelity simulation effects and their connection with educational practices in early nursing education. BMC Nurs. 2025;24(1):457. doi:10.1186/s12912-025-03077-x DOI: https://doi.org/10.1186/s12912-025-03077-x
Moraes EMB, Carvalho DRS, Sandars J, et al. Unravelling the differences between observation and active participation in simulation- based education. Med Teach. 2024;1-6. doi:10.1080/0142159X.2024.2396381 DOI: https://doi.org/10.1080/0142159X.2024.2396381
Li Y, Chen Y, Wei G, et al. Application of desktop virtual reality technology in nursing student education: a realist review. BMC Med Educ. 2025;25(1):78. doi:10.1186/s12909-025-06697-8 DOI: https://doi.org/10.1186/s12909-025-06697-8
Reed JM, Dodson T, Phillips L, Petrinec A. Measuring Debilitating and Facilitating Anxiety Within Nursing Simulation. Nurs Rep. 2024;15(1):1. doi:10.3390/nursrep15010001 DOI: https://doi.org/10.3390/nursrep15010001
Stenseth HV, Steindal SA, Solberg MT, et al. Simulation-based learning supported by technology to enhance critical thinking in nursing students: scoping review. J Med Internet Res. 2025;27:e58744. doi:10.2196/58744 DOI: https://doi.org/10.2196/58744
Yılmaz H, Stephen T, Gundermann C. Effects of Simulation on Nursing students' Knowledge and Learning Related to Measles Vaccine and Vaccine Hesitancy: A Mixed Method Study. Nurs Health Sci. 2024;26(4):e13179. doi:10.1111/nhs.13179 DOI: https://doi.org/10.1111/nhs.13179
Mapulanga P, Msiska M, Msosa A, et al. Strategies supporting the implementation of simulation-based education in nursing and midwifery in Malawi: A mixed methods study. Afr J Health Prof Educ. 2024;16(4):138-142. Disponível em: https://hdl.handle.net/10520/ejc-m_ajhpe_v16_n4_a7 DOI: https://doi.org/10.7196/AJHPE.2024.v16i4.1116
Wolf M, Marks J. Standardizing Graduate Simulation to Increase Nurse Practitioner Student Competency: An Urgent Need. Colo Nurse. 2024;124(4). Disponível em: https://research.ebsco.com/linkprocessor/plink?id=008133ea-c55a-3225-8cc6-989bea80df5c
Dias AAL, Souza RS, Eduardo AHA, Felix AMS, Figueiredo RM. Validação de dois cenários de simulação clínica para ensino de prevenção e controle de infecções relacionadas à assistência à saúde. Rev Eletr Enferm. 2022;24:70072. doi:10.5216/ree.v24.70072 DOI: https://doi.org/10.5216/ree.v24.70072
Bortolato-Major C, Mantovani MDF, Feli JVC, et al. Fatores estressores de estudantes de enfermagem em diferentes cenários simulados. Cienc Enferm. 2023;29. doi:10.29393/CE29-14FECR70014 DOI: https://doi.org/10.29393/CE29-14FECR70014
Downloads
Published
Issue
Section
License
After the final approval, authors must send the copyright transfer agreement signed by the first author representing each additional author. This agreement must state any conflicts of interest.
Athena - Health & Research Journal https://localhost/athena is licensed under a License Creative Commons - Attribution-NonCommercial 4.0 International. 
